肾综合征出血热患者血糖水平与疾病严重程度相关性研究

Correlation between blood glucose and disease severity in patients having hemorrhagic fever with renal syndrome

目的探讨肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)患者的血糖水平与疾病严重程度的相关性。方法选取2012年2月至2021年8月间解放军联勤保障部队第九〇〇医院收治的139例确诊HFRS患者,进行回顾性分析。根据住院期间空腹静脉血浆最高血糖值将患者分为4组并比较其临床资料;根据有无糖皮质激素治疗分为激素治疗组和无激素治疗组,在无激素治疗组应用限制性立方样条确定血糖阈值;通过单因素/多因素线性回归、单因素/多因素逻辑回归分析,评估血糖水平与疾病严重程度指标如白细胞计数、C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)、血小板计数(platelet count,PLT)、凝血酶原时间(prothrombin time,PT)、部分活化凝血酶原时间(activated partial thromboplastin time,APTT)、住院天数、病程等之间的关系;调整激素治疗后,进一步分析血糖与疾病进展的关系。结果4组患者在年龄、血糖水平、CRP、PCT、PT、住院天数、病程、激素治疗等方面差异均有统计学意义(P均<0.05)。血糖参考阈值为6.6 mmol/L、10.0 mmol/L。单因素线性回归或单因素逻辑回归显示,HFRS患者最低PLT、最高CRP、最大PT、最大APTT等与血糖水平相关;无激素治疗组中血糖水平还与最高PCT、最高白细胞计数、住院天数和病程相关。多因素线性回归提示无激素治疗组中血糖每上升1 mmol/L,最大PT增加0.19(95%CI:0.07~0.31)倍,最大APTT增加1.79(95%CI:0.97~2.62)倍,住院天数增加0.58(95%CI:0.20~0.96)倍,病程增加0.58(95%CI:0.17~0.99)倍。血糖水平每上升1级,最大PT值增加0.63(95%CI:0.15~1.10)倍;住院天数延长1.60(95%CI:0.05~3.15)倍。调整糖皮质激素治疗后的多因素线性回归提示血糖每上升1级,住院天数延长1.48(95%CI:0.17~2.80)倍;而疾病分型、转归与血糖水平未见相关(P均>0.05);糖皮质激素治疗与住院天数延长(P=0.020,P=0.040)、血液净化相关(P=0.030)。结论HFRS患者空腹静脉最高血糖值可能与疾病严重程度相关,空腹血糖6.6 mmol/L及10.0 mmol/L可能是提示病情疾病进展的阈值,需要大样本前瞻性试验进一步研究;糖皮质激素治疗与住院天数延长相关,临床使用应谨慎。

Objective To investigate the correlation between blood glucose level and disease severity in patients having hemorrhagic fever with renal syndrome(HFRS).Methods A retrospective analysis was conducted on 139 confirmed HFRS patients admitted to the 900th Hospital of the PLA Joint Logistics Support Force from 2012 to 2021.Patients were divided into four groups based on the highest fasting venous plasma glucose levels during hospitalization for comparative clinical data analysis.Patients were also categorized into two groups based on hormone treatment(Class I/Class II).Restricted cubic spline were applied to determine the glucose threshold in the non-hormone treatment group.The relationship between blood glucose and disease severity indicators such as white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),platelet count(PLT),prothrombin time(PT),partial thromboplastin time(APTT),length of stay,and disease course was assessed using univariate and multivariate linear regression,as well as univariate and multivariate logistic regression analysis.The relationship between blood glucose and disease progression was further analyzed after adjusting for hormone treatment.Results Statistically significant differences were found among the four groups in terms of age,blood glucose,CRP,PCT,PT,length of stay,disease course,and hormone treatment(P<0.05).The reference thresholds for blood glucose were 6.6 mmol/L and 10.0 mmol/L.Univariate linear or logistic regression analysis showed that the lowest PLT,highest CRP,maximum PT,and maximum APTT in both patient groups were correlated with blood glucose levels.In the non-hormone treatment group,blood glucose was also correlated with the highest PCT,highest white blood cell count,length of stay,and disease course.Multivariate linear regression indicated that in the nonhormone treatment group,for every 1 mmol/L increase in blood glucose,the maximum PT increased by 0.19(95%CI:0.07-0.31),the maximum APTT increased by 1.79(95%CI:0.97-2.62),“the”length of stay increased by 0.58(95%CI:0.20-0.96),and the disease course increased by 0.58(95%CI:0.17-0.99).For every one-level increase in blood glucose,the maximum PT value increased by 0.63(95%CI:0.15-1.10);the length of stay was prolonged by 1.60(95%CI:0.05-3.15).After adjusting for hormone treatment,multivariate linear regression suggested that for every one-level increase in blood glucose,the length of stay was prolonged by 1.48(95%CI:0.17-2.80).No correlation was found between blood glucose and disease classification or outcome(P>0.05);hormone treatment was associated with prolonged length of stay(P=0.020,P=0.040)and blood purification(P=0.030).Conclusion The highest venous plasma blood glucose levels in HFRS patients may be correlated with the severity of the disease.Venous plasma blood glucose of 6.6 mmol/L and 10.0 mmol/L may serve as thresholds indicating disease progression,requiring further investigation with large-sample prospective trials.Hormone treatment is associated with prolonged length of stay,and its clinical use should be approached with caution.